Nurse-led innovation: ‘I think nurses need to take the initiative’

Carolyn Scott discusses the potential for nurses to bring about change in general practice with Jenny Aston, advanced nurse practitioner and ambassador/educator for Cambridge and Peterborough Training Hub. This article is part of the Nursing in Practice How Nurses Count campaign.

How would you like to see nurses in general practice responding to the 10 year health plan?

‘Looking at the planned shift of care from hospital to community, I think nurses need to take the initiative.

‘Because they haven’t designed all the details of the 10 year plan yet, there is a good opportunity to think about how the changes might happen where we are.

‘Could we look at an area that we’re good at – let’s say, wound care.

‘How can we work better inter professionally in wound care? How can we work with the district nursing team so it’s an integrated plan?

‘The same would perhaps go for working with health visitors or social navigators around improving immunisations uptake.

‘How can we bring more people in and maybe use something like group clinics to discuss fear of vaccinations?

You pioneered group clinics in general practice. Were they difficult to get off the ground?

‘I wanted to bring in group consultations for the practice – this was about seven years ago. We had so many prediabetic patients then.

‘I could see we needed to do something to intervene and educate more people about diabetes. We had hundreds of newly diagnosed diabetic patients a year.

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‘So, we put in place a process by which we picked them up, contacted them, and offered them the opportunity to come to a group clinic. It was an important step for prevention.’

‘We organised it all quite quickly. We thought about the problem that needed solving, and I brought someone in for training, set it up and started running it.

‘For us, it was a straightforward process of: Here’s a problem, here’s a proposed solution and this is what it will cost in my time. Then we pulled together the figures at the end.’

Does proposing a new idea to the practice team need a more formal process now?

‘I think there’s a lot of power in somebody presenting a proposal that’s planned and costed.’

‘For me, though, a business plan is not that fancy.

‘It’s about demonstrating the issue, and what I want to achieve. These are the resources; the people I need, and an approximate costing. And this is how I’m going to evaluate it and what I hope to see at the end of it.’

Is there time for nurses to plan and put forward new ideas?

‘Now more of the money should be coming into the community, it would be good if we can release some of our nurses time to think about this.

‘I think nurses are very innovative. But they need time, support, and some of the practical skills of how to how to write a business plan.’

‘For example, it’s really difficult to quantify, but would a longer, more meaningful, appointment with a nurse in the practice lead to better care for the patient?

‘I think it’s important to have time to think and plan to build up an idea.

‘But nurses don’t often get given time to do that.

‘Rarely do nurses have time to think, or to build up a plan for changing practice.

‘If they do, most will just do it in their own time, like I did. That’s fine: I chose to do that, but I think the generation of nurses we have coming through is not going to tolerate that so much. In the same way that they will not want to pay for their own training like I did then.’

‘Nurses might want to propose that they should develop in a clinical area with some relevant training, to help support patients better.

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‘How do we improve access for women? Can they write a business plan to say how they might increase the uptake of cervical screening or immunisations?

And can nurses sometimes be held back from doing this?

‘I think we can all think about something that could be done better for the patient. What could we do differently that’s going to improve their experience?

‘All practices need to be looking to improving things for their patients. I hear it all the time from people I know saying they can’t get an appointment at their practice, and they’re right, they can’t.

‘But I think that many GPNs don’t feel they will be listened to.

‘There’s a whole range of things that nurses do really well, but they don’t talk about it.

‘I think that the general lack of trust [from patients] now is because people like general practice nurses don’t have that time if they did. Healthcare assistants do a fabulous job, but they are task driven.

‘A general practice nurse looks at the whole patient. The patient has come in for a leg dressing, but I’m thinking about their mental health, their family context, and the socio economics as well – the whole patient.

‘We have the awareness, the antenna, and that experience that enables a general practice nurse to pick up on things that perhaps would be missed in more of a tick box task driven approach.

‘We also need to help nurses to feel more valued. For me, if you’ve got a happy member of staff, you’ve got healthier patients.

‘My advice to GPNs right now is to join a forum, and access training to help them develop, but also to think about relevant conversations around career development, and what they can do differently in the practice.’

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